What To Know About Hospice Medicare Claims

1. The Medicare Hospice Benefit is paid under Medicare Part A, the hospitalization benefit.

When electing hospice, the patient forfeits their Medicare Part B, or outpatient insurance, for all care related to the terminal condition. Patients also forgo the use of their Medicare Part D prescription drug benefit when electing hospice, for all medications used to treat the terminal condition and related conditions.

2. Hospices are required to notify Medicare of every hospice election within five calendar days.

This means you must file a clean Notice of Election for every patient who elects the hospice benefit with your agency. You must also file NOTRS within five days for all patients who revoke their Medicare Hospice Benefit or discharge from your services. Sounds simple, right?  The process of filing the NOE/NOTR is simple enough, but there are many outside factors that can affect the timeliness of the election- previous hospice elections, improper transfers, and incomplete billing by past hospices call all block your NOE/NOTR from processing and subsequently prevent your claims from paying timely.

3. Open MSP policies can prevent Medicare from paying your claims.

When checking eligibility for Medicare patients, it’s imperative that you know how to read the MSP page and what action to take based on the information found there. Do you know the difference between the types of policies you may find here? Do you know who to call to determine if that MSP policy is truly primary? What if the policy is out of date and should be closed? Not knowing how to interpret and act on the MSP page information cannot only delay claims, but many times cost you the entire reimbursement amount if you don’t act quickly.

4. Medicare requires hospices to bill sequentially.

If one monthly claim does not pay for any of the reasons listed above (or any one of dozens of other reasons), your subsequent claims will not process or pay. Months of claims can sit unprocessed and unpaid as the result of one error on one claim.

5. Hospice claims must be filed and processed within one year of the dates of service.

Again, when claims do not process timely, subsequent claims can stack up, unpaid. Timely filing can become a problem quickly if errors are not corrected promptly and outstanding claims are not worked consistently.

6. The rules are always changing.

The hospice billing update that took place July 2, 2018 was one of the most significant changes to the hospice billing process since CR8877, yet many billers are unfamiliar with the update and how it impacts claims processing. The Medicare Administrative Contractors are having issues processing some claims as a result of the changes, and those issues are ongoing. Are you aware of those processing issues and how they are affecting your revenue?

7. Outsourcing your hospice billing will improve accuracy and collections.

Would you like a solution to all of the above? Outsourcing hospice billing to a robust team of highly trained and experienced professionals will improve your revenue and reduce your AR, giving you more predictable cash flow. There is a distinct advantage to having a billing team who is continuously trained not only on billing but on best practices driven by regulatory and compliance rules.

Please contact Advanced Hospice Management for more information about how we can collect more of your money, faster